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NPI Code Detail

MEDICARE: SHALAHA CALHOUN

MEDICARE: SHALAHA CALHOUN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician010050NY

General Provider Information

NPI Number : 1891346458
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHALAHA CALHOUN
Provider Business Mailing Address
First Line : 11605 N LAMAR BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78753-2658
Country : US
Telephone Number : 737-222-6996
Fax Number : 512-522-8836
Provider Business Practice Location Address
First Line : 10204 FLATLANDS AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-2810
Country : US
Telephone Number : 718-306-5503
Fax Number : 718-257-4033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2019
Last Update Date : 09/25/2019

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Directions to “ SHALAHA CALHOUN ” Practice Location

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